Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00338
T l c. AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 1 S136AD06505
Jurisdiction: Tigard
Site address: 10998 SW 68TH PKWY
Project: Golsan - Bailey Subdivision: WAY LEE Lot: B
Project Description: (1) sink
Contractor: MCINNIS INDUSTRIES LLC Owner: GOLSAN, KEN
PO BOX 920 10998 SW 68TH PKWY
BEAVERTON, OR 97075 TIGARD, OR 97223
PHONE: 503 - 643 -6343 PHONE: 503 - 244 -0297
FAX: 503 - 643 -6343
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 11/20/2012 $25.02
Specifics: 1 12% State Surcharge - 11/20/2012 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 11/20/2012 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /�
Issued By: "Magi,/ J ^ n Permittee Signature: Ctl thifue 4 I IO L
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV -18 -2012 06:02 PM McINNIS INDUSTRIES 503 579 1341 P.01
Plunnj)inu Permit Aa>alit>:atioF CEIVE
Site Utilities , ,' i I I 1 1 1 , r `I ,
NOV 1 9 2012 l Fe>Y aitNo.:
City of Tigard DeC/BY: Ili a-0 I a-- I" Piii A/„). - A9 33
II , 13125 SW Hall Blvd., Tigard, OR P� Review
Phone: 503.718.2439 Fax: so3. OF TIGARD nat,/gy, Ott Parma No.: Re
In n Line: 503.639.4175 BUILDING DnVnS10Pt i e a° ymy: la s.. latarmetloo
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ddition/alteration/replaecmad ❑ Other New 1- 2 -famll dwellings includes 100 R for each utili connection)
n ,� a ,z a w f , ,' , s i , ' i; SFR (l) bath 312.70
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SFR (2) bath 437.78
❑ I- and 2- family dwelling 151 CanmerciallmdusMal SFR (3) bath 50032
❑ Accessory building ❑Mull- lhmily Each additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler (__ sq. ft.) Page 2
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Job site address: / 9 e 5� ( % ".../ ,-,,,, Catch basin or area drain 18.76
Drywdil, leech Inc, or trench limit 18.76
City/Stetc/ZIP: I
I�r. -� Footing drain (no. (inset it.: Page 2
suite/bldgfi pt. no.: Project name. 41i I SC G - 1x•41 l Manufkctured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
- .. Rain drain connector 18.76
,. b V i (iit Ti Sanitary sewer (no. limit; Page 2
Storm sewer (no. linear R: ) Page 2
Water service (no. line r IL: ,_) Page 2
Subdivision: I Lot no.: _ Nature or Item:
Tax map/parcel no.: Bacd:fiaw presenter 31.27
� K ,. G • .. i t r r , :, Y .I T r ', ;; I 'i vane 12.51
25.02
1 �' r tF F Clothes washer
c Y Lr . r ' 1 Backwater
r , / Dishwasher 25.02
I Oink erg twain 25.02 ,
Ejeotors/sump . 25.02
'y 1.', � +.
,r .,.M ', ''',.,`•`:,''', ∎ ri�
11 �t . r i s r' :sJ.,i , i ct s ∎:' Expansion tank 12.51
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.. - .54 i1 .!•;;;" . :tl : X',, ,.., , frt„ r
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Name; �, � � Fixture/sewer cap 25.02
Address; / 0 9 1 5 ; / 1L iG ✓ sink/hub 25.02
City /Stair/ZIP; t.,�� n Hose bi 25.02
6
Phone: (c - • . . 0.- la Fax: ( ) loo maker 12.51
+
L t fV , t W v t , t 7 ;t.' i r '„ ',,,,T t` ,. , ',, , , a t ,I InterCep<Origrea4e flap 25.02
�.1,: p ia .., : i ! �s r 1, t ;6 . i'ir. f, _ <. ,! . 4,1
gas (value: S ) • ` ge 2
J N 4 .. - + N Printer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: SiniJbesin lavatory 4) 25.02 J L
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub/shower/shower pan 12.51
E- rnail: Urinal 25.02
p i ' T h�e , r t . A A y y ' > i Y � i , e M ii
v ' , 1 t `� , t U u ',Y , ,.:j Water Closet 25.02
•A 'i w ,� J ?ice 11+ ..' 1.. ,.,� . ..:P . 1.
. . ,. it.' i , . yy e .. , ., f v 3 c - . i Water healer 37.52
Business name: C j r), hA.. L-1...4__ Water ptping/DWV 56.29
Address: 7, ., it'a.. 7.'' Other: 25.02
Subtotal S6 �'�
City /statelZlP: T� E", a 9 � J
Phone: ( ,!,) er e,,,) , 7 46 Fax: ( ) 11/4.1 11(114, Minimum permit fee: 572.5; q Z.,4-7.1 CCB Lic.: J e7 2314 12 I( Plumbing Lic. no.: Leigp;
State surcharge (12% of permit fee) , f2
Authorized signature: �( TOTAL PERMIT FEE I
Print name: C4Q ✓ < y�, . it el ( t 15 I Date: `/ I/g f i V/ �° �� ■ e'eka We permit h not obtained days
Y after It has been accepted as complete
'Fee methodology set by Di- Building Industry Service Board
L'mud#PerniiawtMU- PumaM0.aoe rorobOS 4 04etat(1ero2M.0M/WEB)
P.03
AUTOMATIC COVER SHEET
DATE : NOV-18-2012 06:04 PM
TO :
FAX U: 5035981960
FROM : McINNIS INDUSTRIES
FAX U: 503 579 1341
3 PAGES WERE SENT
(INCLUDING THIS COVER SHEET)